May 2025 Cutting Edge Newsletter

May 2025 Cutting Edge

Jump to "Editor’s Note"
Jump to "Executive Director's Report"
Jump to "May is Injury Prevention Awareness Month"
Jump to "Bylaws Change"
Jump to "The AAST Associate Membership Update"
Jump to "The ABCs of Pediatric Trauma Triage"
Jump to "Disaster Committee Update"
Jump to "The Fellowship of the Book"
Jump to "Normalizing Inequities: State of Research in a Post-DEI Society"
Jump to "Multi-Institutional Trials Committee Update"

Editor’s Note
Written by: Shannon Marie Foster, MD, FACS

Executive Director's Report
Written by: Sharon Gautschy 

Happy Spring!

The AAST has been busy over the last few months.  The Program Committee and the Board of Managers met in late March and held two very productive meetings.  The Program Committee selected the oral and quickshot presentations, and Dr. Nirula chose the posters. Please check the Annual Meeting section of the website for the abstracts, lunch details, pre-session and add-on session descriptions, and program information. 

The scholarship committee conducted interviews and chose the research scholarships for the 2025-2026 academic year. Check the Cutting Edge for research descriptions and the recipients. 

I know it is only May, but June is just around the corner, which means that registration for the AAST Annual Meeting will soon open.  Watch the Week-in-Review for the announcement.  Also, don’t forget to book your hotel room!

Besides the Annual Meeting, AAST offers additional educational opportunities, including Grand Rounds, the AAST/PTS Virtual International Trauma Case Conference, committee webinars, and JTACS CME. Visit the AAST Educational page (https://www.aast.org/education/overview). 

Don’t forget to visit the AAST website regularly, especially the rotator and the Don’t Miss sections! 

See you in Boston!
 

Prevention Committee​

May is Injury Prevention Awareness Month
Written By: Stephanie Bonne, MD

As many of us know, May is Injury Prevention Awareness month, and a great time for an update from the injury prevention committee.  We have been off to a great start since our last AAST meeting!  Our committee has been hard at work writing proposals, catching up on the latest research, preparing for our “Defying Gravity” webinar in May, and planning our Stop the Falls Event for our meeting in Boston. 

Injury Prevention Month Activities

The Prevention Committee participates as a member of the Trauma Prevention Coalition, and our partner organization, the ATS, has provided the attached link for National Trauma Awareness Month activities.  In addition to injury prevention month resources and activities, they are hospital a webinar entitled “Falls, Fender-Benders and Firearms: Leveraging Safety Programs that Work” on May 19.  We encourage you to share this link with your teams and attend this webinar!

National Trauma Awareness Month 2020 - American Trauma Society

We also encourage AAST members to tag AAST social media (@traumadoctors) with photos and links to your centers’ injury prevention efforts in May.  Consider honoring your centers’ injury prevention professionals with a special thank you, a note, an email, or a small gift during this month.  Without the partnership of your injury prevention coordinator, the trauma centers would not be able to perform much of the life saving prevention work that we do.

Update on the CDC Injury Center

The Centers for Disease Control and Prevention’s Injury Center is an important agency supporting our work as trauma surgeons.  The Injury Center includes vital statistics such as the Web-based Injury Statistics Query and Reporting System (WISQARS), the National Violent Death Reporting System (NVDRS) as well important grant making mechanisms, such as support for nine National Injury Control Research Centers, and Firearm Injury Research Grants.  Unfortunately, the CDC Injury Center’s funding is threatened by cuts from the federal government.  In the 2024 Congressional budget, the injury center was cut by the House of Representatives, but was spared when the spending bill went to the Senate.  Recently, the AAST Board of Managers approved the AAST to participate in a coalition being led by Safe States, to highlight the important work of the injury center and the ways in which the Injury Center's data systems are critical to our academic work.

However, even as this article was being written, news came down that health secretary Robert F. Kennedy Jr. has directed the layoffs of entire teams at the CDC Injury Center, including the teams focused on injuries we see daily in our trauma centers, such as motor vehicle collisions, elderly falls, and traumatic brain injury.  This is a developing story, but will affect our ability to monitor basic epidemiology of traumatic injuries and respond to them in our trauma centers and our injury prevention efforts.   More information can be found here: CDC injury prevention team faced major cuts, putting critical work at risk : Shots - Health News : NPR

If you would like more information or would like to participate in the Safe States effort, please contact Stephanie Bonne at [email protected]
 

AAST Board of Managers

Bylaws Change
Written by: Clay Cothren Burlew, MD

At the March 26, 2025 Board of Managers Meeting, the Board of Managers approved an update to the AAST Bylaws.

1. Article IV Standing Committees (Page 6), Sections 4.1 & 4.2

• The Board has approved a change in name and composition.

2. Article VII Dues and Fees (Page 9), Section 5 and 5.1

• Change in senior status from 65 to 70 for those still practicing.  Members under 70 who retire from clinical practice will not have to pay dues. 

These bylaw changes will be read and voted on during the Annual Business Meeting, which will be held on Friday, September 12, 2025, at 5:00 p.m. Eastern at the Boston Marriott Copley Place in Boston, MA.

Please send any comments to Sharon Gautschy, [email protected].

Thank you

Pediatric Committee​

The ABCs of Pediatric Trauma Triage
Written By: Robert W. Letton, Jr., MD, FACS, FAAP

Triage is the assignment of the degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties.  It is also essential in determining the resources necessary with respect to the individual patient arriving to the trauma center.  Undertriage is worse for the patient as necessary resources are not mobilized, and most centers want to have a rate less than 5%.  Overtriage is better for the patient but can stress the system if the trigger is pulled too often, and centers shoot for a rate less than 30%.

So, how do we determine triage in the field?  The ACS COT VRC mandatory triage criteria for highest level activation is one mechanism.

• Confirmed blood pressure less than 90 mmHg at any time in an adult, and age-specific hypotension in children
• GSW to the neck, chest or abdomen
• GCS less than 9 with mechanism attributed to trauma
• Transfer patients from another hospital who require ongoing blood transfusion
• Patients intubated in the field and directly transported to the trauma center
• Patients with respiratory compromise or in need of an emergent airway
• Transfer patients from another hospital with ongoing respiratory compromise (excludes patients intubated at another facility who are stable from a respiratory standpoint)
• Emergency Physician’s Discretion

Often this list is expanded to include locally important mechanisms of injury, and many pediatric trauma centers have added button battery ingestion as an activation criteria do to the significant hemorrhage that can potentially occur.

Does mechanism really matter?  Back in the day a T-bone rollover mechanism would automatically be activated as a highest-level activation just based on mechanism.  But the significant safety advances that have occurred in the past 10-20 years have been significant, and often people just walk away from the scene.  Also, applying adult triage criteria to children is not necessarily sensitive or specific enough due to different common injury patterns as well as different physiologic response.  The Holy Grail of triage would be that one number one could call from the field that accurately and consistently resulted in appropriate triage and response to injury.

Shock index, pulse divided by systolic pressure, has been a useful number for adult trauma triage, with a score greater than 1 being worrisome.  Drs. Acker, Bensard, Moulton and others in Denver have looked at shock index, and have developed a pediatric adjustment, and have numerous papers validating SIPA (Shock Index Pediatric Adjusted)¹.

(SIPA outperformed SI p<0.001)

However, children don’t experience hemorrhagic shock as frequently as the adult trauma population, and we all know that traumatic brain injury is an important injury that is not accounted for in the SIPA.  The same group in Denver accounted for this in the rSIG, reverse shock index (SBP/pulse) times the GCS.  In this instance, the lower the number, the more potentially injured the child².

It is sometimes difficult to calculate an accurate GCS in an infant and toddler.  Their natural response whether they are injured or not is to close their eyes and not respond to anyone but mommy or daddy. I have had patients in clinic that won’t open their eyes, localize pain if I touch them, and won’t say a word, calculating out to a GCS 7.  Recent evidence has shown that the GCS motor score alone is as sensitive and specific as the total GCS score.³  Two years ago, at the Pediatric Trauma Society meeting, we presented a modification of the rSIG, the rSIM, where we only used the motor score component of the GCS (SBP/PULSE times GCSm) and compared it to the rSIG.⁴

rSIM performs as well as rSIG and is slightly easier to calculate, and we feel in the infant and toddler population it could give more consistent.  This was chosen as one of the Top 24 Papers in JTACS in 2024, and currently we are putting together a prospective validation trial through the A+ Pediatric Trauma Research Network.  

The most common method of determining undertriage and over triage has been the Injury Severity Score based Cribari method.  One difficulty with this is that if is highly dependent on injury identification, and cannot be calculated easily, in fact, sometimes it cannot be calculated until the medical examiner performs an autopsy.  A paper in JTACS in 2019 comparing events that compose the Need for Trauma Intervention (NFTI) compare it as a triage tool alone versus ISS/Cribari and Revised Trauma Score.⁵

• Receiving packed red blood within 4 hours of arrival
• ED discharge to operating room (OR) within 90 minutes
• ED discharge to interventional radiology
• ED discharge to intensive care unit (ICU) with ICU length of stay (LOS) ≥3 calendar days
• Nonprocedural mechanical ventilation within 72 hours of arrival
• Mortality within 60 hours of arrival

As it can be calculated at least within the first hours to day’s it is a more useful tool for looking at the quality or performance issues in real time rather than weeks to months later.  Many centers have put Cribari and NFTI together when looking at over and under triage.

Accurate trauma triage is essential for the patient’s needs as well as ensuring the trauma center is not overwhelmed.  There have been significant advances with non-mechanistic tools that can hopefully give us the Holy Grail of accurate and consistent trauma activations.

 Robert W. Letton, Jr., MD, FACS, FAAP
Professor of Surgery, Mayo Clinic School of Medicine and Science
Albert H. Wilkinson, Jr., MD, Endowed Professor and Chair of Surgery
Nemours Children’s Healthcare Jacksonville
Surgeon in Chief
Wolfson Children’s Hospital

REFERENCES

1. Acker SN, Bredbeck B, Partrick DA, Kulungowski AM, Barnett CC, Bensard DD. Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation. Surgery. 2017 Mar;161(3):803-807. doi: 10.1016/j.surg.2016.08.050. Epub 2016 Nov 1. PMID: 27814956.
2. Reppucci ML, Cooper E, Nolan MM, Lyttle BD, Gallagher LT, Jujare S, Stevens J, Moulton SL, Bensard DD, Acker SN. Use of prehospital reverse shock index times Glasgow Coma Scale to identify children who require the most immediate trauma care. J Trauma Acute Care Surg. 2023 Sep 1;95(3):347-353. doi: 10.1097/TA.0000000000003903. Epub 2023 Mar 11. PMID: 36899455.
3. Brown JB, Forsythe RM, Stassen NA, Peitzman AB, Billiar TR, Sperry JL, Gestring ML. Evidence-based improvement of the National Trauma Triage Protocol: The Glasgow Coma Scale versus Glasgow Coma Scale motor subscale. J Trauma Acute Care Surg. 2014 Jul;77(1):95-102; discussion 101-2. doi: 10.1097/TA.0000000000000280. PMID: 24977762; PMCID: PMC4620030.
4. Smida T, Bonasso P, Bardes J, Price BS, Seifarth F, Gurien L, Maxson R, Letton R. Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J Trauma Acute Care Surg. 2024 Sep 1;97(3):393-399. doi: 10.1097/TA.0000000000004258. Epub 2024 Jan 26. PMID: 38273438; PMCID: PMC11272904.
5. Roden-Foreman JW, Rapier NR, Foreman ML, Zagel AL, Sexton KW, Beck WC, McGraw C, Coniglio RA, Blackmore AR, Holzmacher J, Sarani B, Hess JC, Greenwell C, Adams CA Jr, Lueckel SN, Weaver M, Agrawal V, Amos JD, Workman CF, Milia DJ, Bertelson A, Dorlac W, Warne MJ, Cull J, Lyell CA, Regner JL, McGonigal MD, Flohr SD, Steen S, Nance ML, Campbell M, Putty B, Sherar D, Schroeppel TJ. Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019 Sep;87(3):658-665. doi: 10.1097/TA.0000000000002402. PMID: 31205214

Disaster Committee​

Disaster Committee Update
Written By: Brad Chernock, MD and Adam Fox, DO

Disaster events from the last several decades (i.e. 9/11, Hurricane Katrina, multiple mass shootings, Haiti Earthquake, Boston Marathon bombing and COVID-19) have led to the increasing recognition that the trauma surgeon must be proficient in disaster preparedness and medicine.  Not only does the Verification Review Committee of the Committee on Trauma require a trauma surgeon be included as a member of a hospitals disaster committee (Standards manual 2.3) but also successfully complete (in Level I Adult and Pediatric centers) the Disaster and Emergency Preparedness (DMEP) course (Standards manual 4.35).

Today, the available options for disaster education are numerous and many exist in an on-line format.  The American College of Surgeons has been providing the DMEP course since the early 2000’s and has recently added a complimentary course, the Advanced Disaster Medical Preparedness Course (ADMR).

DMEP/eDMEP Course
The DMEP course is designed to teach the planning, preparedness, and medical management of trauma patients during mass casualty incidents. Available in both live and on-line versions, the course provides the learner information on disaster response with a focus on hospital response.  The live, in-person course is an engaging, instructor-led, one day event.  For those who prefer on-line learning, eDMEP offers the same comprehensive content with added interactive scenarios to reinforce key concepts.  Upon completion, each participant will have gained an understanding of all aspects of the disaster continuum of care. To access information on both courses, visit https://www.facs.org/quality-programs/trauma/education/disaster-management-and-emergency-preparedness. Participants can earn 4 Category 1 CME credits.

Advanced Disaster Medical Preparedness Course
A recent addition to the ACS educational offerings, this well-established live course has been updated into an on-line offering and delves into disaster response in different ways from the DMEP course.  Different modules take the learner into multiple core principles of disaster response with focuses on incident management and command, triage, evacuation and several special populations. Optional modules are available to further enhance learning. The ADMR course is available to both physicians and nurses at https://www.facs.org/quality-programs/trauma/education/advanced-disaster-medical-response/#:~:text=The%20Advanced%20Disaster%20Medical%20Response,the%20cause%20of%20the%20disaster. Participants can earn 7 Category 1 CME (physician) or CE credits (nursing).

Multiple other offerings can help expose, prepare, and educate the surgeon in disaster response. To view other educational opportunities and other disaster related resources, please visit the AAST Disaster Committee webpage at https://www.aast.org/disaster-management or reach out to any Disaster Committee member.

The Fellowship of the Book
Written By: Jennifer Hartwell, MD, Stepheny Berry, MD, Tanya Anand, MD, MPH, and Leah Tatebe, MD

“We are always told to read books on leadership, but no one ever explains anything, we never actually talk about learning leadership and making it real for us in our own institutions”, we lamented, over wine, one evening at a society meeting.

The light bulbs went off and thus was born, The Fellowship of the Book, founded and led by Jennifer Hartwell MD, Stepheny Berry MD, Tanya Anand MD MPH, and Leah Tatebe MD, in March 2022. Since then, the Fellowship of the Book e-mail “member” list has grown to nearly 120 people, mostly surgeons.

Our goal was to create a safe, relaxed “place” to talk about a book we read, discuss current situations we are facing and how to apply what we are learning to real life scenarios. We choose books that we believe will have a broad appeal to the membership but are applicable to our work. Sometimes the book is a suggestion by a FoB member; some books are chosen because we have seen them on social media; others are recommended by the bookshop owners at the local shop we frequent. We have read everything from Daniel Pink and Adam Grant, to Viola Davis’s autobiography; a memoir about COVID; Susan Cain’s “Quiet” (a hit with introverts!); to “Smart Brevity” by VanderHei, Allen & Schwartz. We are always challenging ourselves to learn and think differently. We always invite the author of our chosen book and have had several authors join our Zoom call!

Each month, we send an email to the membership list announcing the book choice, the date of the Zoom discussion meeting, and a calendar invite with the Zoom link included. On the Zoom, we typically have 8-12 people, which we have found to be a comfortable number to keep the conversation flowing, though from time to time our group has been larger which allows more comfort for some people to be listeners and others, talkers. The atmosphere is very casual, and people are welcome to come late, leave early, eat dinner or have a glass of wine; cameras off or cameras on; some join while on-call at work; others from their favorite spot at home. We always enjoy cameos by kids and pets, and we frequently remind the group: Rule #1 of Book Club: You don’t have to read the book to join the discussion!

We are excited about the continued growth of Fellowship of the Book. Anyone is welcome!

If you are interested in joining Fellowship of the Book, send an email to: [email protected] and follow us on X: @bookfellowship.

Volunteer for An AAST Committee by August 1, 2025!

Multi-Institutional Trials Committee​

Multi-Institutional Trials Committee Update
Written By: Kevin Schuster, MD, MPH, Galinos Barmparas, MD, and Navpreet Dhillon, MD

The Multi-Institutional Trials Committee (MITC) continues to review and work with investigators to advance their studies towards AAST approved multi-center studies. We have approved one new study in the last quarter. We continue to seek new submissions for AAST multi-center studies and look forward to collaborating with investigators to develop these into active studies. As of May 1^st of this year the AAST data collection tool hosted by Infotech will be closed. If you are participating in an active AAST multicenter study that uses the Infotech platform and you have not adjusted, please reach out to the study PI or study coordinator at the primary center.

The Coalition for National Trauma Research (CNTR) has recently contracted with the Department of Defense to reinvigorate the National Trauma Research Repository (NTRR) which will be built using the Biomedical Research Informatics Computing System (BRICS) architecture within the NIH. The NTRR will be the home of all federally funded clinical and translational trauma research study data. The MITC has been actively engaged in this effort defining required variables and their definitions using the frameworks provided by the National Trauma Data Bank (NTDB) and Federal Interagency Traumatic Brain Injury Research (FITBIR) repository, among others.

The survey subcommittee led by vice-chair Galinos Barmparas, Paul Albini, James Byrne, and Anaar Siletz is finalizing the new process for AAST membership surveys utilizing the random sample methodology. With this approach, approximately one to two surveys per quarter will be distributed to a representative sample of about 130 members, rather than the entire membership. Members selected for participation will be asked to commit to responding to all surveys over a one-year period. This model is designed to ensure a higher response rate and improve the scientific validity of survey findings. There will be requests in the coming weeks to update your member profile and identify if you would be willing to participate in future surveys.

The MITC survey subcommittee and the research mentorship subcommittee, led by Mayur Patel, are also collaborating with Navpreet Dhillon, our representative to the AMC, who is developing a survey of junior and mid-level faculty that are AAST fellows or AMC members. The survey will assess the needs of these groups with respect to mentorship across a range of professional development areas including, but not limited to clinical leadership, educational leadership and research.